CDOCS a SPEAR Company

3D Imaging

Thomas Monahan Rich Rosenblatt
12 years ago

I recently purchased the Sirona XG3D 2D pan/ 3D cone beam.  It is quickly changing my practice and my ability to diagnose my patients.  A patient came in yesterday. I  took BW's during his checkup.    Upon exam we saw this tooth with a chipped interproximal composite that had cracks on the distal. I was debating b/t an onlay and crown.  He had no discomfort on tooth previously and he didn't even notice that it was chipped.  I took a PA for insurance purposes.

 

This is the pre op PA with my new schick 33's.  It looks like maybe some decay under the composite. 

He comes in this morn and I start prepping and decide the crown is the best option.  I begin to take out the old composite for a new build up. The composite falls out and this is what I see:    

I show him this photo and tell him that I'm going to have to do endo.  I put composite into that space, prep it to ideal and image to make crown while doing endo.  I then open a new window and image the prep as a pre op so I can make a biocopy of the core and just bond that right in when the endo is completed.  After both images are done, I create an endo access.  The m and d canals are necrotic and the palatal canal looks huge and it is bleeding like crazy.  I could not get it to stop.  I inject some septocaine into what I thought was the canal and get some hemostasis but not total.  I take a pic and this is what I see.  (all these pics are just with my IOC since I was not planning on documenting this one):

  I'm thinking that there must be internal resorbtion and that this tooth may need extraction and a graft for a future implant.  I go and take a scan on him.  Check out the tangential view on this screen shot (I put a white arrow on where to look):    

It appears there is a lingual perforation from internal resorbtion.  I look at the PA to see how I could overlook something so huge.  When I went back, I noticed the darkening in the furca area, but it probed normal and pt never complained of any discomfort so I didn't pay it any mind.  If I would have scanned him first, I could have just planned for the extraction and graft instead of wasting all the time I did with the other stuff.  Amazing what 3D can show you!!!!

 

 

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